Provider Demographics
NPI:1417729765
Name:BUNN, JAMIE NICOLE (ACNP)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:NICOLE
Last Name:BUNN
Suffix:
Gender:
Credentials:ACNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-355-3003
Mailing Address - Fax:314-747-0917
Practice Address - Street 1:11155 DUNN RD
Practice Address - Street 2:DIV SURG CT ADULT CARDIO, STE 209E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6150
Practice Address - Country:US
Practice Address - Phone:314-355-3003
Practice Address - Fax:314-747-0917
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023040159363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420132982Medicaid